There’s a running joke in state government that nobody is sure what a state’s lieutenant governor is actually supposed to do -- it’s so ingrained that a candidate for the Wisconsin job once ran a campaign ad that tried to answer that very question. "You just stand around and wait for the governor to die. It's a plum job," Wisconsin State Sen. Alan Lasee, who had sought to eliminate the position, told the Milwaukee Journal-Sentinel in 2010, reflecting a broader perception that, if there’s one government post less powerful than the vice presidency, it might be a lieutenant governorship.

But Maryland Lt. Gov. Anthony Brown didn’t want to sit around and do nothing when he assumed the office in 2007. The only job description he had, as laid out in the state constitution, was “the duties delegated to him by the governor”. (We should stop and note that each state has a different structure for its lieutenant governor. Some are elected on a ticket with the governor, as in Maryland; others run for the position on their own).

So as Brown and Gov. Martin O’Malley prepared to commence their terms, the lieutenant governor and governor sat down and outlined a strategy that would allow Brown to be active in the administration and the state’s policymaking. It was “a natural extension of my background” in the Maryland House of Delegates, where he served for eight years, Brown told the audience at Governing’s Outlook in the States and Localities conference Wednesday in Washington, D.C.

“I told him that this needed to be more than calling the governor’s house every morning and asking if the governor is still with us,” Brown said with a laugh. “This needed to be a meaningful opportunity.”

So they agreed on some issues where Brown would take an active role: health care, economic development and higher education. He’s since added domestic violence, foster care and adoption, and veterans issues. Brown served in the U.S. Army before moving to public service and is the highest-ranking elected official in the country to have served a tour of duty in Iraq.

That’s a full plate.

Health care, in particular, “has kept me busy,” Brown said. “The real action is in the states to implement the Affordable Care Act.”

He’s chaired the Maryland Health Care Reform Coordinating Council, the state body responsible for overseeing all the various pieces of implementing the federal health reform law. That’s included creating a health insurance marketplace, selecting benchmarks for health insurance sold in the state and preparing for the expansion of Medicaid in 2014.

Brown has also been the force behind Maryland’s creation of health enterprise zones: a spinoff of more well-known economic development zones, but this time aimed at reducing health disparities in socioeconomically disadvantaged community. The three-year, $12 million project allows community coalitions to identify the disparity they want to reduce -- say, higher rates of diabetes among low-income African-Americans -- and gives them flexibility in how they do so. (Governing covered the initiative in depth in its health newsletter last month.)

Brown has also become a vocal advocate for public-private partnerships. He oversaw a commission that delivered recommendations to O’Malley last year, laying out how the sometimes controversial concept could be a boon for the state’s economy. They placed a specific focus on infrastructure -- as the Baltimore Sun reported earlier this month, the commission has estimated partnerships could pay up to $315 million toward projects and create as many as 4,000 jobs. Brown has set a goal of having five projects funded through partnerships ongoing simultaneously.

"We're big on partnerships in Maryland. In the economy we've been facing, we ought to be,” Brown said Wednesday. "It's more than the private sector's dollars. It's the private sector's ingenuity."

And if that effort and others prove successful, Brown could find himself moving up to O'Malley's seat. Governing's Lou Jacobson has already pegged Brown as the early frontrunner for the 2014 Maryland governor's race.